Managing short term menopausal symptoms

Question 1

Short term mangement of vasomotor symptoms in menopause

Answer 1

• HRT oestrogen and progestogen to women with a uterus
• HRT oestrogen alone to women without a uterus.
• Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.
• Explain to women that there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms

Question 2

Short term management of psychological symptoms in menopause

Answer 2

• Consider HRT to alleviate low mood that arises as a result of the menopause.
• Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

Question 3

Short term management of sexual dysfunction in menopause

Answer 3

• Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective

Question 4

Short term management of urogenital atrophy in menopause

Answer 4

• Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.
• Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated.
• If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose.
• They should report unscheduled vaginal bleeding to their GP.

Question 5

Schedule of review of short term treatment of menopause

Answer 5

• At 3 months to assess efficacy and tolerability
• Annually thereafter unless there are clinical indications for an earlier review (such as treatment ineffectiveness, side effects or adverse events).